Laboratory Medicine Updates - October 6, 2004

University of Virginia Health
System

Medical Laboratories

“Quality You Expect, Service
You Deserve”

LABORATORY MEDICINE
UPDATE

October 6, 2004

Handling of New Liquid Specimen
Traps

The 70 mL Specimen Trap available from the hospital store room (bin
# 92401) now comes with a separate, solid cap to prevent leakage during
specimen transportation. After collecting the specimen, remove
and discard the original cap with attached tubing. Securely
attach the solid cap to the container. Once placed into a
zippered biohazard bag, the specimen may be transported through the
hospital pneumatic tube system to the Medical Laboratories.

New Reports Available in
CAS

The Cytogenetics, Flow Cytometry and Molecular Diagnostics
Laboratories have begun reporting results in the CoPath system.
For cases received in the laboratories on or after September 1, 2004,
final results for Cytogenetics studies and the interpretive results for
Flow Cytometry and Molecular Diagnostics testing are being reported
electronically in the system. Once the results are finalized, a
copy is faxed automatically to the requesting physician and the results
are electronically transmitted to the CAS system. The results are
available under the Surgical Pathology heading. If you experience
problems retrieving results, please contact Customer Service at 4-LABS
(434-924-5227).

Change in
Directorship

Dr. Orieji Illoh, Director of the Immunology (Davis) Laboratory,
will be relocating with her family to Texas in early November where she
has accepted another academic appointment. Dr. Lloyd Gray will
assume the directorship of the laboratory on November 5, 2004.
Medical Laboratories and the Department of Pathology wish Dr. Illoh all
the best.

Requests for Digoxin
Levels

When placing an order for a Digoxin level, please use the “Digibind”
comment only if the
patient has received a dose of the antidote. Use of the comment
when the patient has not received Digibind will delay availability of
the results.

Physician (Credentialed
Practitioner) Orders for Laboratory Tests

Audits completed by the Hospital Corporate Compliance Office
revealed opportunities for improvement regarding physician orders for
laboratory tests. Medicare requires a physician’s order for all
laboratory tests. The order must include the patient’s name,
tests required, date of the order and the physician’s signature.

There is no specific form or format required for the order as long
as the essential information is included. Therefore, some
examples of how this can be accomplished are by having the physician
sign the laboratory request form that includes the patient specific
information, by having a physician enter an electronic order, or by
having the signed clinic note state the tests being done.

Laboratory Relocation
Update

Construction continues at the site for the new building that will
house the relocated Core, Microbiology and Molecular Diagnostics
Laboratories. The revised schedule suggests the building will be
completed in February, 2005 and an internal group is working on a
two-week transition plan to ensure continued testing throughout the
move.

Discussions are underway with major vendors to select the next
generation of chemistry instrumentation for the new site. The
latest instruments offer modular automation platforms, allowing for
more efficient use of technical staff. Work groups have also been
established to address specimen transportation, staff parking and
security, telecommunication/IS requirements, and environmental and
safety concerns.

The Fibrinogen Degradation Product assay (FSP or FDP) is no longer
available as an orderable test in the MIS system. Analysis will
continue to be performed 24 hours a day but can only be ordered as a
consult request. As is now noted in MIS, clinicians must place
the order on a consult form. The Clinical Pathology Hemostasis
resident on-call is available at 1663 for assistance and please contact
the Special Coagulation Laboratory at 4-8007 if you have any
questions.

Recommendations for Monitoring
Aminoglycoside and Vancomycin Serum Concentrations in Infants and
Children

Recommendations for
Monitoring:

No monitoring is needed for:

Patients expected to receive less than 5 days of therapy

Patients > 3 months of age with normal renal function and an
appropriate clinical response

Recommendations for Time of Sample
Draws

Serum concentrations should be obtained after the third dose,
unless the patient has unstable renal function and requires earlier
intervention.

Aminoglycoside peak concentrations should be obtained 30 minutes
after completion of the infusion.

Vancomycin peak concentrations should be obtained 1 hour after
completion of the infusion. Note: For adults or those
receiving adult doses, vancomycin peak concentrations should be
obtained 2 hours after completion of the infusion.

Trough concentrations should be obtained within 30 minutes of the
next dose.

Patients receiving extended interval aminoglycosides (e.g. once
daily gentamicin or tobramycin in an older child) who require serum
concentration monitoring may have a trough concentration drawn and/or
random level taken at 4 to 6 hours after a dose.